Flesh eating bacteria question

[Rred]

mscmicrobiology-
Pardon me for going OT here (mods, feel free to move it).
On the chance that you are involved in microbiology...What are your thoughts on how to deal with cuts and scrapes in areas where so-called flesh eating bacteria have been an issue? My understanding is that there are two main kinds and one apparently is becoming more common in the warmer waters near shorelines. I did ask DAN, and they were a bit unsure.
I'm thinking that considering the potential damage from that type of infection, any wound should be thoroughly cleaned and disinfected. But, would something simple (Wound Wash, Bactine, the similar benzelconium based cleaners) used generously be enough to kill that kind of surface bacteria? Or would the nuclear option (like H Peroxide) be the way to go? Since peroxide kills everything including healthy tissue and creates a good breeding ground for bacteria, I'm reluctant to use it unless necessary.

 

[mscmicrobiology]

The two most common bacteria I am familiar with that can complicate lacerations (or even abrasions) that are common in seawater are Vibrio parahemolyticus and Vibrio vulnificus. The first is starting to show up more and more along the US and Canadian coast, moving North as waters are gradually warming. The second one has been around much longer and can cause necrotizing infection (flesh eating). Covering lacerations/cuts to limit exposure to circulating seawater would be the first line of defense. Second line would simply be a vigorous rinse in fresh water after the dive. If you really wanted to cover your bases then a mild disinfectant like iodine (betadine) or alcohol would work. As you mentioned, peroxide is the nuclear option but I only tend to use it as part of the initial wound care for a new injury but avoid for already healing injuries as it will essentially dissolve the forming scab and granulation tissue necessary for proper healing and ultimately slow recovery time. As with all infection control, there is no way to reduce risk to zero but following some of these steps would reduce the odds of infection dramatically. If you ever have a normal looking injury and the erythema (redness) around it progressively spreads after exposure to seawater then I would seek a physician for some antibiotics that would cover Vibrio spp.

I also would also avoid eating raw shellfish as these Vibrio also tend to get concentrated in the shellfish and can infect you through ingestion without suffering any external injury.

 

[pauldw]

Where on the medical form do you put down your vibrio infection?

 

[mscmicrobiology]

LOL, isn’t there a section for flesh eating “zombie” bacterial infections? Probably right beside congenitally malformed earlobes - yes/no.

 

[Blueringocto_73]

Not a medical professional. However almost succumbed to "gram negative" staphylococcus. Just a small blister on big toe that became infected in sea water. Extensive IV penicillin derivatives saved me.

 

[Duke Dive Medicine]

@Rred , immunocompromised people are at higher risk: cancer patients, elderly, very young, anyone on immunosuppressive drugs, but anyone can get serious infection from fresh or salt water through an open wound. Vibrio vulnificus has been the one implicated most often of late. CDC only tracks necrotizing fasciitis caused by group A beta hemolytic strep so not sure if vibrio nec fasc is on the rise, but it's certainly getting a lot of media attention lately. Plain soap and water is a fine disinfectant if you get a cut or scrape while in the water. If you have a current cut or scrape and want to swim or dive, the conservative advice is to stay out of the water. Realizing that some will not heed this advice, good-quality occlusive dressings like Tegaderm are an option. You have to watch any of those types of dressings though, as they can come loose and/or be sweated off.

Best regards,
DDM

 

[Bowers]

spray on bandaid is a great way to cover areas of concern before getting in the water.

 

[Blueringocto_73]

I should amend my earlier reference to having a staphylococcus infection. In fact I suffered from (GBS) otherwise known as Group B Streptococcus.

It's a highly dangerous infection when introduced to a wound. Which in my case was a small open blister.

The use of analogues for Penicillin due to resistance that the bacterium has acquired helped in my case. However I was outpatient on regular Penicillin for 7 weeks. Administering the IV myself with a Penicillin pump into my arm which then passed into the chest cavity.

 

[gert7to3]

Should you suffer a cut, abrasion or puncture from coral or an urchin spine, thoroughly debriding the wound is a good first step. Even if you clean or disinfect the wound, leaving a bit of urchin spine or coral flake in it could harbor some bacteria.